Appendix 1. Frailty as a confounder of the effectiveness of preventive treatment. Abbreviations: t1 = time one. t2 = time 2. This model indicates the
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1 Appendix 1. Frailty as a confounder of the effectiveness of preventive treatment. Abbreviations: t1 = time one. t2 = time 2. This model indicates the interrelatedness of comorbidity, frailty, and ADL dependency, supporting the choice of ADL dependency as a proxy for frailty. Comorbidities increase the risk for ADL dependency 28 and frailty, but ADL dependency and frailty, due to inactivity and other mechanisms, may aggravate or unmask comorbid conditions. 1
2 Appendix 2a. Final Weighted Model Predicting ADL-Dependence: Parameter Estimates (SE) and Codes Intercept Age (centered: Age-65) Age-centered Squared Female gender Non-Hispanic Black Race Hispanic/Latino Non-Hispanic Other Race Cancer Screening V76. Lipid Abnormality Parameter Estimate SE Associated ICD-9, CPT or HCPC Codes Vertigo , , Arthritis , 711., 712., 714., 715., 716.5, 716.6, 716.8, 716.9, 718., 719.0, 719.1, 719.4, 719.5, 719.9, 725. Bladder Dysfunction , 599.6, 788.2, Podiatric Care , 700., 703. Heart Failure , 428., 429.0, 429.1, 429.3, Psychiatric Illness , 291., 292., 293., 294., 295., 296., 297., 298., 299., 300.0, 310., 311. Rehabilitation care V57.1, V57.21, V57.3, V57.8, V57.9 Home oxygen E1390, E1391, E1392, E0431, E0433, E0434, E0435, E0439, E0441, E0442, E0443 Hypotension Or Shock , 785.5, 958.4, Ambulance Transport A0426, A0427, A0428, A0429, A0999 Stroke/Brain Injury , , 430., 431., 432., , , , , , , , , 436., 852., 853., 854. Dementias , 294., 331., , , , 438.0, , 797. Parkinson's Disease Weakness , 728.3, , 799.3, V49.84 Skin Ulcer Paralysis , 344., 438.2, 438.3, 438.4, 438.5, Wheelchair E1050, E1060, E1070, E1083, E1084, E1085, E1086, E1087, E1088, E1089, E1090, E1091, E1092, E1093, E1100, E1110, E1140, E1150, E1160, E1161, E1170, K0001, K0002, K0003, K0004, K0005, K0006, K0007, K0008, K0009 Hospital Bed E0250, E0251, E0255, E0256, E0260, E0261, E0265, E0266, E0270, E0290, E0291, E0292, E0293, E0294, E0295, E0296, E0297, E0301, E0302, E0303, E0304, E0316 Note: Unless otherwise indicated, all codes should be interpreted as starting with the digits listed. For example, 707. includes 707, 707.x and 707.xx codes: 707, 707.0, , , , , , , , , , 707.1, , , , , , , , 707.2, , , , , , , 707.8,
3 Appendix 2b. Final Weighted Model Predicting ADL-Dependence: Parameter Estimates (SE) for Models Excluding Race Parameter Estimate Intercept Age (centered: Age-65) Age-centered Squared Female gender Cancer Screening Lipid Abnormalities Vertigo Arthritis Bladder Dysfunction Podiatric Care Heart Failure Psychiatric Illness Rehabilitation Home oxygen Hypotension Or Shock Ambulance transport Stroke/Brain Injury Dementias Parkinson's Disease Weakness Skin Ulcer Paralysis Wheelchair Home hospital Bed SE
4 Appendix 2c. s not significantly associated with ADL-Dependence Associated ICD-9, CPT, or HCPC codes Abnormal X-ray 793. Back problems 720., 721.4, , 722., 723., 724. Cancer 145., 146., 148., 150., 151., 152., 153., 154., 155., 156., 157., 158., 159., 160., 161., 162., 163., 164., 165., 166., 167., 168., 169., 170., 171., 172., 174., 175., 182., 183., 188., 189., 190., 191., 192., 193., 194., 195., 196., 197., 198., 199., 200., 201., 202., 203., 204., 205., 206., 207., 208., 209., 239. Coronary disease 410., 411., 412., 413., 414. Coagulopathy 286.6, 286.7, 286.9, 287.4, COPD 490., 491., 492., 493., 494., 496. Dehydration , Delirium 293.0, 293.1, , , , , Difficulty walking 719.7, 781.2, 781.3, V46.3 DM complications 250.4, 250.6, 250.7, Dysphagia 787.2, Electrolyte abnormalities 276.0, 276.1, 276.2, 276.3, 276.7, 276.8, Falls E880., E881., E882., E883., E884., E885., E886., E887., E888., E929.3 Hip/pelvic fractures 808., 820., V43.64 Renal failure 581., 583., 584., 585., 586. Liver diseases 070., 570., 571., 572., 573., 789.5*, (*EXCLUDING 789.5x codes other than ) Medication reaction 960., 961., 962., 963., 964., 965., 966., 967., 968., 969., 970., 971., 972., 973., 974., 975., 976., 977., 978., 979., E930., E931., E932., E933., E934., E935., E936. E937., E938., E939., E940., E941., E942., E943., E944., E945., E946., E947., E948., E949. Physician inpatient consult 99251, 99252, 99253, 99254, Other fractures 800., 801., 802., 803., 804., 807., 809., 810., 811., 812., 813., 814., 815., 816., 817., 818., 819., 821., 822., 823., 824., 825., 826., 827., 828., 829. Pneumonia 480., 481., 482., 483., 484., 485., 486., 487., 488., Peripheral vascular disease 440. Respiratory distress/failure 507.0, 512., 518.0, 518.4, 518.5, 519.0, V44.0, V46.1, V46.2, V55.0 Sepsis 010., 011., 012., 013., 014., 015., 016., 017., 018., 031.0, 031.2, , , 036., 038., 040.0, 041., 053.0, , 054.5, 112.5, , , 136.3, 320., 321., 681., 682., 730., 785.4, Physician SNF visit 99304, 99305, 99307, 99308, 99309, 99310, Valve disease 394., 395., 396., 397., 424. Walker E0130, E0135, E0140, E0143, E0144, E0147, E0148, E0149, E0154, E0155, E0156, E0157, E0158 Weight loss 783.2, , 783.7, Herpes zoster 053. Relevant code groups that did not meet 1% prevalence criteria for inclusion in models Aphasia, dysphasia 438.1, 784.3, Bowel dysfunction , 787.6*, (*EXCLUDING 787.6x codes other than ) Malnutrition 261., 262., 263. Neutropenia 288.0*, , , , (*EXCLUDING , ) Pulmonary embolus Vertebral fracture 805., 806. Note: Unless otherwise indicated, all codes should be interpreted as starting with the digits listed. For example, 805. includes 805, 805.x and 805.xx codes: 805, 805.0, , , , , , , , , , 805.1, , , , , , , , , , 805.2, 805.3, 805.4, 805.5, 805.6, 805.7, 805.8,
5 Appendix 2d. Final Weighted Model Predicting ADL-Dependence: Parameter Estimates (SE) by Region Northeast c-statistic:0.859 Midwest c-statistic:0.850 South c-statistic: West c-statistic:0.840 Estimate SE Estimate SE Estimate SE Estimate SE Intercept Age (centered: Age-65) Age-centered Squared Female gender Non-Hispanic Black Race Hispanic/Latino Other Non-Hispanic Race Cancer Screening Lipid Abnormality Vertigo Arthritis Bladder Dysfunction Podiatric Care Heart Failure Psychiatric Illness Rehabilitation care Home oxygen Hypotension Or Shock Ambulance Transport Stroke/Brain Injury Dementias Parkinson's Disease Weakness Skin Ulcer Paralysis Wheelchair Hospital Bed Estimates are derived from a logistic regression model controlling for all other variables in the model.
6 Appendix 3. Receiver Operating Curve for Prediction of ADL-dependency Using Claims Data
7 Appendix 4: Predictors of 6-month mortality Model 1 c-statistic: Model 2 c-statistic: Model 3 c-statistic: Model 4 c-statistic: Age (centered: Age-65) 1.09 (1.07, 1.12) 1.06 (1.03, 1.08) 1.03 (1.00, 1.05) 1.07 (1.04, 1.10) Female gender 0.76 (0.53, 1.08) 0.64 (0.45, 0.92) 0.60 (0.42, 0.86) 0.71 (0.49, 1.03) Race/Ethnicity Non-Hispanic White 1.00 (ref) 1.00 (ref) 1.00 (ref) 1.00 (ref) Non-Hispanic Black 1.75 (1.00, 3.04) 1.42 (0.81, 2.51) 1.29 (0.73, 2.27) 1.58 (0.88, 2.84) Hispanic/Latino 0.42 (0.06, 3.05) 0.45 (0.06, 3.33) 0.50 (0.07, 3.67) 0.36 (0.05, 2.77) Other Non-Hispanic 2.27 (1.08, 4.78) 1.51 (0.70, 3.28) 1.33 (0.62, 2.84) 2.46 (1.13, 5.37) ADL-D 7.40 (5.08, 10.78) Probability of dependency < 5% 1.00 (ref) 5-< 10% 1.94 (1.10, 3.43) 10-< 20% 3.33 (1.81, 6.13) 20-< 40% 7.67 (4.13, 14.25) 40% or more (6.50, 21.51) Claims Cancer Screening 1.23 (0.79, 1.93) Lipid Abnormalities 0.76 (0.52, 1.10) Vertigo 0.60 (0.31, 1.15) Arthritis 0.85 (0.58, 1.26) Bladder Dysfunction 0.84 (0.44, 1.58) Podiatric Care 1.11 (0.61, 2.03) Heart Failure 1.78 (1.17, 2.73) Psychiatric Illness 0.91 (0.53, 1.56) Rehabilitation care 1.17 (0.62, 2.21) Home oxygen 3.27 (1.96, 5.46) Hypotension or Shock 2.31 (1.19, 4.49) Ambulance transport 1.76 (1.05, 2.95) Stroke/Brain Injury 1.49 (0.82, 2.72) Dementias 2.02 (1.16, 3.54) Parkinson's Disease 1.42 (0.48, 4.23) Weakness 1.63 (0.89, 2.96) Skin Ulcer 1.31 (0.67, 2.55) Paralysis 0.88 (0.27, 2.79) Wheelchair 0.67 (0.30, 1.47) Hospital Bed 2.12 (0.99, 4.52)
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